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1804 


Walters 

...  An  inaugural  dissertation  on  inflammation 


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AN 

INAUGURAL  DISSERTATION 

ON 

INFLAMMATION. 

SUBMITTED  TO  THE  PUBLIC  EXAMINATION  OF  THE 

FACULTY  OF  PHYSIC 

UNDER  THE  AUTHORITY  OF  THE  TRUSTEES  OF  COLOMBIA  COLLEGE, 
IN  THE  STATE  OF  NEW-YORK, 

The  Right  Rev.  BENJAMIN  MOORE,  D.D.  President; 

FOR  THE  DEGREE  OF 

DOCTOR  OF  PHYSIC, 

On  the  £"<  Day  of  May,  1804. 

BY  DANIEL  D.  WALTERS. 


NEW-YORK: 


Printed  by  T.  (3  J.  SWORDS,  Printers  to  the  Faculty  of  Physic 
of  Columbia  College. 

1804. 


JX-PU-SSW?/: 


PREFACE. 


X?  OR  publishing  an  Inaugural  Dissertation  of  the  nature, 
and  under  the  circumstances  of  the  present,  no  apology  is  to 
be  made,  as  it  is  only  complying  with  an  ordinance  of  col- 
lege. 

By  way  of  preface,  however,  the  reasons  which  dictated 
the  choice  of  the  subject  may  be  mentioned,  as  well  as  a  few 
seeming  objections  to  the  general  doctrine  answered. 

The  first  and  principal  reason  which  determined  me  in  the 
choice  of  Inflammation^  as  a  subject  for  discussion,  was  the 
impossibility  which  existed  in  my  own  mind  to  accept  the 
theory  advanced  of  that  disease  by  the  principal  writers  of  the 
day.  The  second  was,  that  I  believed  that  if  I  could  excite 
some  inquiry  on  the  subject,  it  would  not  be  altogether  use- 
less, however  far  I  myself  may  have  fallen  short  of  proving 
the  correctness  of  the  opinions  advanced.  For  a  just  theory 
of  inflammation  once  attained,  it  appears  to  me  would  be  the 
unravelling  clew  to  a  knowledge  of  those  motions  in  which 
that  great  scourge  of  our  existence,  fever,  consists;  a  theory 
more  to  be  desired  by  the  scientific  physician  than  that  of  all 
other  diseases  put  together. 

Many,  no  doubt,  will  observe,  that  I  have  taken  some 
things  for  granted,  the  truth  of  which  they  themselves  ques- 
tion. For  instance,  I  have  constantly  spoken  of  the  fibres  of 
which  the  brain  and  nerves  are  composed,  as  contractile. 
Now,  notwithstanding  these  fibres  have  not  been  seen  to  recede 
from  the  edge  of  the  surgeon's  knife,  yet,  when  we  cease  to 


iv  PREFACE. 

talk  about  the  nerves  contracting,  we  must  also  cease  to  talk 
about  the  nervous  influence,  vis  nerva;,  &c.  For  even  ad- 
mitting for  a  moment  that  the  nerves  act  by  a  fluid,  passing 
with  infinite  velocity  from  the  brain  to  their  extremities,  the 
difficulty  still  remains  the  same ;  for  this  fluid,  in  order  to  act, 
must  be  in  motion ;  a  moving  power  must,  therefore,  be  ad- 
mitred.  This  power  is  presumed  to  be  nothing  short  of  con- 
tractility in  the  nervous  fibre. 

It  may  also  be  observed,  that  I  have  said  in  the  Introduc- 
tion, that  it  is  necessary  for  relaxation  to  alternate  with,  or 
soon  follow  spasm,  on  account  of  the  great  quantity  of  the 
vital  principle  expended  by  the  energy  of  such  contraction. 

The  principle  here  contended  for  is  believed  to  be  well 
founded,  notwithstanding  a  case  of  trismus  may  seem  to  point 
to  a  different  conclusion.  For,  in  order  to  account  for  the 
continued  state  of  contraction  of  the  muscles  concerned  in 
trismus,  we  must  refer  to  the  great  quantity  of  action,  and 
proportional  quantity  of  blood,  to  which  a  habit  of  acting 
constantly  has  inured  them.  I  have  said  that  sensibility,  irri- 
tability, &c.  were  diminished  in  inflammation.  Some  may, 
perhaps,  urge  the  great  sensibility  of  the  retina  in  cases  of 
opthalmia  as  an  objection  to  this  theory.  Such,  however, 
may  be  answered,  that  the  retina  is  not  the  seat  of  the  disease, 
but  so  near  to  it  as  to  be  highly  excited  by  it.  So  in  all  other 
cases  of  increased  sensation. 


INTRODUCTION. 


INTRODUCTORY  to  the  following  Dissertation, 
I  shall  briefly  consider  the  structure,  as  well  as  se- 
veral of  the  motions  of  the  solid  parts  of  animal 
bodies,  so  far  as  these,  from  their  vascularity,  or 
from  their  being  made  up  of  irritable  and  con- 
tractile fibres,  are  enabled  to  perform  all  those  mo- 
tions which  peculiarly  belong  to  life.  I  do  this, 
because  it  appears  to  me  that  the  proximate  cause 
of  every  degree  of  health  is  to  be  found  in  peculiar 
changes  of  motion,  and  correspondent  variations 
of  structure,  of  the  parts  above-mentioned. 

The  contractile  fibres  entering  into  the  structure 
of  animal  solids  generally,  are  of  two  kinds,  viz. 
the  muscular  and  nervous.  The  former  of  these, 
while  they  enjoy  a  large  portion  of  the  living  prin- 
ciple, possess  the  power  to  contract,  on  the  appli- 
cation of  a  stimulus,  without  producing  sensation ; 
nor  are  they  capable  of  acquiring  such  power  by 
frequent  stimulations  and  contractions.  The  latter, 
while  they  enjoy  a  large  portion  of  the  living  prin- 
ciple, possess  the  power  to  contract  in  like  man- 
ner, on  the  application  of  a  stimulus;  but  by  their 
contractions  they  produce  sensation,  or  by  frequent 


6  On  Inflammation. 

stimulations  and  contractions,  acquire  the  power 
to  produce  sensation.* 

These  different  kinds  of  fibres  are  differently  dis- 
posed of  throughout  the  several  parts  of  animal 
bodies,  according  to  the  various  requisites  of  sense 
and  motion.  Hence,  in  some  instances,  the  mus- 
cular fibres  chiefly  contribute  to  the  formation  of 
parts,  as  in  the  locomotive  muscles ;  while  in  others 
they  are  mostly  made  up  of  the  nervous,  as  in  se- 
veral of  the  organs  of  sense.  These  fibres,  whe- 
ther muscular  or  nervous,  are  all,  at  least  as  far  as 
inquiry  has  been  made  on  the  subject,  connected 
together  laterally  by  the  cellular  membrane,  and  are 
every  where  interspersed  with  the  fine  extremities 
of  the  arteries  which  supply  blood  for  the  follow- 
ing purposes,  namely,  for  the  secretion  of  lubri- 
cating fluids,  that  the  parts  may  move  easily  over 
each  other,  for  the  secretion  of  materials  to  cause 
the  growth  and  reparation  of  the  solids,  and  for 
the  secretion  of  the  vital  principle  and  of  sensible 
caloric. 

The  secretion  of  the  fluids  last  named,  and  their 
connection  with  the  contractile  fibres,  must  be  fur- 
ther noticed,  after  observing  that  I  do  not  hesitate 
to  adopt  the  opinion  of  the  illustrious  John  Hun- 
ter, with  respect  to  the  vitality  of  the  blood. 

Like  all  other  secretions  made  from  the  blood, 
those  of  the  vital  principle  and  sensible  caloric  will 

*  Daily  observation  teaches  us,  that  the  nerves,  from  frequent  stimula- 
tion, very  much  increase  their  power  of  producing  sensation  :  this  is  called 
habit.   May  we  not  thence  infer  that  all  sensation  was  originally  acquired ! 


On  Inflammation.  7 

be  greater  or  less  in  proportion  to  the  quantity  of 
blood  perfectly  circulated;  that  is,  the  greatest 
quantity  of  blood  circulated  by  the  greatest  ar- 
terial action,  affords,  in  all  cases,  the  most  copious 
secretion  of  the  vital  principle  and  sensible  caloric. 
The  evidence  of  this  fact  is  observed  on  the  gene- 
ral system,  in  the  first  effects  resulting  from  the 
administration  of  general  and  diffusible  stimuli,  as 
alcohol  or  exercise  ;  locally,  in  those  accumulations 
of  life  and  heat  which  often  occur  in  the  neigh- 
bourhood of  inflammations. — But  more  of  this  here- 
after. 

The  quantity  of  blood,  however,  remaining  the 
same,  it  is  easy  to  increase  the  action  of  the  arte- 
ries to  a  certain  extent,  by  the  application  of  sti- 
muli, thereby  increasing  proportionably  the  secre- 
tion of  the  vital  principle  and  sensible  caloric.  On 
the  knowledge  of  this  fact  medical  prescription  is 
principally  founded. 

.  The  vital  principle  simply,  connected  with  the 
contractile  fibres,  cause  their  irritability,  that  is,  their 
capability  to  contract  when  stimulated;  and  may, 
therefore,  in  this  state  of  union,  be  considered  as 
the  remote  cause  of  fibrous  contraction.  And  their 
irritability  is  increased  or  diminished  in  proportion 
as  the  quantity  of  the  vital  principle  with  which 
they  are  connected  is  greater  or  less;  and  the  quan- 
tity of  the  vital  principle  was  shown  above  to  cor- 
respond to  the  quantity  of  blood  circulated,  and 
the  action  of  the  arteries  conjointly.  From  all  this 
it  appears  that  there  can  be  no  accumulation  of 


8  On  Inflammation. 

the  vital  principle,  irritability  or  excitability,  in 
any  part  of  the  system,  when  the  action  of  the  ar- 
teries is  suspended,  as  in  syncope. 

Hence  a  fundamental  part  of  the  doctrine  of 
Brown  and  Darwin  is  believed  to  be  erroneous. 
This  doctrine,  however,  will  obtain  a  further  con- 
sideration below. 

Having  already  hinted  at  the  remote  cause  of 
fibrous  contraction,  I  shall,  in  this  place,  inquire 
what  other  causes  more  immediately  conduce  to 
that  curious  phenomenon.  These  I  shall  divide 
into  proximate  and  exciting. 

The  proximate  cause  of  fibrous  contraction  I 
conceive  to  be  some  motion  or  affection  of  the 
vital  principle  in  or  through  the  contractile  fibres. 
This  opinion  is  strengthened  by  the  following  fact— 
in  fibrous  contractions  the  vital  principle  is  expended. 
Now,  it  seems  probable  that,  in  order  to  expend 
the  vital  principle,  it  is  only  necessary  to  separate 
it  from  its  connection  with  the  contractile  fibres: 
but  to  separate  it  is  to  move  it:  no  separation  can 
take  place  without  motion,  and  this  motion,  which 
ends  ultimately  in  its  separation  and  expenditure, 
appears  to  be,  in  all  cases,  the  proximate  cause  of 
fibrous  contraction. 

The  exciting  causes  of  fibrous  contraction  are 
the  impulses  of  external  bodies.  Now,  as  all  bo- 
dies stimulate  or  affect  the  contractile  fibres,  by 
peculiar,  commonly  called  sensible  qualities  or  pro- 
perties, the  fibrous  contractions  which  they  excite 
must  also  be  peculiar;  and  as  the  fibrous  contrac- 


On  Inflammation,.  9 

tions  thus  excited  are  the  ideas  of  sensation,  these 
ideas  will  be  as  different  from  each  other  as  the 
impulses  of  the  bodies  exciting  them,  whether  they 
bear  any  resemblance  to  the  bodies  which  excited 
them  or  not.  The  essential  characteristic  of  all 
impulses  is  motion;  impulses  may,  therefore,  be 
defined  the  peculiar  or  sensible  properties  of  bodies 
in  motion ;  and  as  these  impulses  lead  us  to  an  ac- 
quaintance with  the  external  world,  it  may  be  que- 
ried whether  any  body  exists  in  nature  in  a  state  of 
rest  or  inactivity. 

An  attempt  to  enumerate  all  the  causes  of  im- 
pulse would  be  fruitless ;  yet  some  of  those  most 
constant  in  their  operation  may  be  pointed  out;  as 
the  blood  and  other  circulated  fluids,  in  their  ap- 
propriate vessels  and  glands;  as  food  and  other 
matters  in  the  stomach  and  intestinal  canal;  and  as 
fibrous  contractions,  especially  those  which  consti- 
tute the  ideas  of  extremely  painful  or  pleasurable 
sensation,  in  the  neighbourhood  of  other  contrac- 
tile fibres,  which  are  liable  to  be  excited,  and  in 
their  turn  excite  other  fibrous  contractions,  consti- 
tuting what  has  been  called  sympathy,  at  least  as 
far  as  that  habit  of  action  appears  to  be  well 
founded. 

So  necessary  is  it  that  the  exciting  causes  of 
fibrous  contraction  should  constantly  operate,  that  it 
may  not  only  be  said  of  them  that  they  force  life 
through  every  moment  of  its  existence,  but  that  they 
constantly  vary  it  as  they  act  more  or  less  intensely. 

The  above  doctrine  may  be  applied,  by  way  of 


10  On  Inflammation. 

illustration,  in  the  following  familiar  example  ;  the 
heart  as  ordinarily  employed  in  the  circulation  of 
the  blood.  The  heart  is  largely  supplied  with 
blood,  principally  for  the  secretion  of  the  vital  prin- 
ciple, whereby  it  is  rendered  irritable,  or  fitted  for 
the  operation  of  an  exciting  cause;  which  is,  in 
this  instance,  the  stimulus  of  distention  during  its 
diastole,  and  which,  operating  upon  the  vital  prin- 
ciple, excites  its  motion  and  ultimate  expenditure 
in  the  systole  of  that  organ.  Physiologists  have  in 
vain  inquired  for  peculiar  qualities  of  the  blood, 
whereby  it  stimulated  the  heart  to  contract;  but 
from  this  view  of  the  subject  it  will  be  easily  seen 
that  it  would  as  readily  circulate  any  other  fluid 
capable  of  distending  it  as  the  one  it  does,  provided 
it  could  be  regularly  supplied  with  the  vital  princi- 
ple. From  a  further  view  of  the  above  example,  I 
am  led  to  make  the  following  conclusion ;  that  the 
quantity  of  motion  that  the  whole  body,  or  any 
part,  is  capable  of  sustaining,  is  regulated  altoge- 
ther by  the  quantity  of  blood  which  the  whole 
body,  or  any  part,  circulates :  for  there  is  no  mus- 
cle in  the  body  which  circulates  so  much  blood, 
and  performs  so  much  motion,  in  proportion  to  its 
quantity  of  matter,  as  the  heart,  and  none  so  badly 
supplied  with  nerves;  which  argues  the  quantity  of 
motion  to  depend  upon  the  quantity  of  blood,  and 
not  upon  the  abundance  of  nervous  influence. 

It  was  above  proposed  to  consider,  in  a  more 
particular  manner,  a  part  of  the  doctrine  advanced 
and  supported  by  Brown  and  Darwin,  which  it 


On  Inflammation.  1 1 

is  believed  they  carried  to  an  unwarrantable  length. 
The  part  I  allude  to  is  this,  "  That  in  direct  debi- 
lity the  excitability  becomes  accumulated;"  or,  in 
other  words,  "  if  fibrous  action  is  diminished  or  sus- 
pended by  withholding,  in  a  greater  or  less  degree, 
its  exciting  causes,  the  excitability  becomes  pro- 
portionably  accumulated/'  By  an  accumulated  ex- 
citability I  understand  an  accumulation  of  the  vital 
principle,  or  some  state  absolutely  dependant  on 
such  accumulation.  The  excitability  is  supposed 
to  be  measured  by  the  quantity  of  action  that  fol- 
lows the  application  of  any  stimulant  power  to  the 
contractile  fibres.  Now,  if  the  stimulant  power  is 
defined  and  applied  under  ordinary  and  known  cir- 
cumstances, and  the  quantity  of  action  which  fol- 
lows this  application  is  also  estimated,  it  is  easy  to 
calculate  from  these  data  the  quantity  of  the  excita- 
bility. Thus,  if  I  apply  alcohol  to  the  ordinary 
and  healthy  surface  of  my  body,  a  certain  quantity 
of  action  and  sensation  is  excited;  the  power  of 
the  alcohol,  which  is  the  exciting  cause,  may  be 
reckoned  as  one;  the  quantity  of  action  excited, 
which  is  compounded  of  the  power  of  the  exciting 
cause,  and  the  quantity  of  the  excitability,  may  be 
reckoned  as1  two:  therefore,  from  a  knowledge  of 
the  exciting  cause,  and  all  the  circumstances  re- 
lating to  its  application,  as  well  as  from  an  estima- 
tion of  the  quantity  of  action  following  such  appli- 
cation, I  conclude  the  sum  of  excitability,  in  this 
instance,  to  be  equal  to  one.  If,  however,  the  same 
exciting  cause  be  applied  under  circumstances  ap* 


12  On  Inflammation* 

parently  the  same,  and  a  quantity  of  action  follow 
equal  to  four,  I  must,  of  necessity,  ascribe  the  in- 
crease of  action  to  an  accumulated  excitability,  for 
we  could  not  charge  more  agency  to  the  exciting 
power  in  this  instance  than  in  the  former,  because 
the  circumstances  attending  its  application  were 
apparently  the  same.  Such  accumulations  of  the 
excitability  do  take  place,  but  not  in  consequence  of 
diminished  excitement  of  the  heart  and  arteries.  If, 
however,  I  vary  the  circumstances,  and  apply  the 
same  exciting  power  to  a  surface,  denuded  of  its 
cuticle,  and  a  quantity  of  action  should  follow 
equal  to  four;  I  could  not,  in  this  instance,  ascribe 
the  increase  of  action  to  an  accumulated  excitabi- 
lity, (for  no  evidence  of  such  accumulation  exists) 
but  to  the  power  of  the  exciting  cause,  which  has 
been  very  much  increased  by  the  mode  of  applica- 
tion. The  instances,  I  believe,  are  not  very  unfre- 
quent  where  deception  obtains  on  this  ground;  for 
we  are  very  apt  to  attend  to  the  quantity  of  action 
or  sensation,  and  judge  from  these  an  accumu- 
lated excitability  to  exist,  without  taking  into  our 
account  any  of  the  circumstances  which  might  have 
doubled  or  tribled  the  power  of  an  exciting  cause. 

Having  admitted  that  accumulations  of  the  vi- 
tal principle,  and  consequently  accumulations  of 
the  excitability,  do  take  place  in  some  portion  of 
the  contractile  fibres,  under  certain  circumstances, 
it  now  becomes  necessary  to  point  out  the  portion 
liable  to  such  accumulations,  and  the  circumstances 
under  which  they  obtain. 


On  Inflammation.  13 

All  that  portion  of  the  contractile  fibres,  whe- 
ther muscular  or  nervous,  as  the  brain  and  voluntary- 
muscles,  which  are   not  immediately  employed  to 
circulate  the  blood,  are  liable  to  accumulations  of 
the  vital  principle,  when  the  contractions  of  these 
are  diminished  in  comparison  to  the  action  of  the 
arteries.      Hence  increased  excitability  and   acti- 
vity after  sleep,  which  is  the  suspension  of  volun- 
tary motion  ;  hence,  too,  increased  susceptibility  to 
light  and  sound,  after  the  eye  has  been  confined  to 
darkness,  or  the  ear  to  silence.     It  must,  however, 
be  recollected,  that  in  sleep,  silence,  and  darkness, 
the  blood  is  regularly  circulated;  therefore  the  vital 
principle  is  regularly  secreted.     If  this  was  not  the 
case,  but  the  action  of  the  arteries  diminished  in 
as  great  a  degree  as  the  contractions  of  the  volun- 
tary muscles  and  organs  of  sense  are  in  sleep,  &c.  no 
accumulation  of  the  vital  principle  could  occur,  there- 
fore no  refreshment  would  follow  sleep,  nor  would 
our  organs  of  sense  experience  increased  suscepti- 
bility to  the  impressions   of  their  appropriate  sti- 
muli, after  such  stimuli  had  been,  for  a  time,  with- 
holden.     All  that  portion  of  the  contractile  fibres 
which  is  immediately  employed  to  circulate  the 
blood,  suffers  no  accumulation  of  the  vital  principle 
that  can  exist  a  longer  time  than  from  one  pulsa- 
tion of  the  arteries  to  the  next  immediately  suc- 
ceeding;  because  every  contraction  can    be  only 
equal  to  the  power  of  its  causes,  and  its  causes  were 
given  and  limited  by  the  contraction  immediately 
preceding.     Hence,  every  contraction  of  the  heart 


14  On  Inflammation. 

and  arteries  will  be  greater  or  less,  in  proportion  as 
the  quantity  of  the  vital  principle  secreted  in  the 
preceding  contraction  was  greater  or  less,  or  in  pro- 
portion as  the  preceding  contraction  was  greater  or 
less.  Hence*  too*  it  will  be  easily  seen,  that  the  heart 
and  arteries  cannot  be  rendered  more  irritable  dur- 
ing sleep,  and  that  no  accumulation  of  the  vital 
principle  can  take  place  in  consequence  of  their 
action  being  diminished;  therefore  no  such  accumu- 
lations occur  in  syncope,  haemorrhage,  or  exposure 
to  low  temperatures. 

It  must  be  observed  before  quitting  this  subject, 
that  all  the  contraccile  fibres,  during  life,  are  liable 
to  exhibit,  at  different  times*  different  degrees  of 
contraction,  or  modes  of  existence,  each  of  which 
gives  a  peculiar  density  to  the  solids,  (for  the  degree 
of  density  is  in  proportion  to  the  degree  of  contrac- 
tion) and  is  marked  by  peculiar  degrees  of  pleasure- 
able  or  painful  sensation. 

The  first  of  these  states  to  be  noticed  is  one 
which  often  obtains  in  disease,  when,  from  the 
small  quantity  of  blood,  or  weakened  action  of  the 
arteries,  the  secretion  and  expenditure  of  the  vital 
principle  is  very  small.  The  greater  degrees  of  this 
state  exhibit  the  most  inconsiderable  quantity  of 
action  compatible  with  life,  and  are  distinguished 
by  the  words,  "  loss  of  tone,  or  laxity  of  fibre." 

The  second  state  to  be  marked  is  one  usually  ex- 
hibited by  the  fibres  in  health,  and  commonly  dis- 
tinguished by  the  words,  "  tone,  or  tonic  state;" 
which  is  a  moderate  degree  of  contraction,   de- 


On  Inflammation.  15 

pendant  on  a  considerable  secretion  and  expendi- 
ture of  the  vital  principle. 

A  third  state  is  that  exhibited  by  the  involuntary 
muscles,  in  the  performance  of  their  healthy  func- 
tions, as  the  heart  and  arteries  in  the  circulation  of 
the  blood ;  and  by  the  voluntary  muscles  in  their  or- 
dinary motions.  In  this  state  the  contractions  are 
so  great  as  to  expend  the  vital  principle  faster  than 
it  is  ordinarily  secreted;  therefore  frequent  relaxa- 
tions become  necessary. 

A  fourth  state  is  that  exhibited  by  the  contractile 
fibres  in  spasm.  The  violence  of  the  contractions 
in  this  state  chiefly  depends  on  the  intensity  of 
the  exciting  cause,  and  expends  much  of  the  vital 
principle ;  hence  relaxations  alternate  with,  or  sooa 
follow  such  contractions. 

Now,  as  the  power  of  the  exciting  causes  of 
fibrous  contractions  is  diminished  in  proportion  as 
the  density  of  the  solids  is  increased,  it  will  be  easily 
seen  why  spasm  so  often  occurs  in  atony,  and  why 
violent  contractions,  once  excited,  (whether  of  the 
muscular  or  nervous  fibres,  as  in  spasm  and  reverie) 
are  not  affected  by  ordinary  exciting  powers.  If 
the  smaller  degrees  of  atony  exist,  and,  at  the  same 
time,  a  paucity  of  exciting  powers,  ennui  will  be  the 
consequence. 

The  second  and  third  states  described  above  are 
attended  with  pleasurable,  the  fourth  with  painful 
sensations. 


(      16     ) 


INFLAMMATION. 

TUMOUR  and  redness  of  any  part  constitute 
inflammation.  I  am  aware  that  Cullen,  Bell, 
and  others,  have  added  to  the  above  symptoms 
those  of  pain  and  increased  heat;  but  as  these  do 
not  always  occur,  and  when  they  do,  are  merely 
accidental,  I  cannot  admit  them  in  the  general  de- 
finition of  the  disease.  However,  as  pain  and  in- 
creased heat  have  so  often  attended  inflammation 
as  to  have  contributed  largely  towards  obscuring 
the  real  character  of  that  disease,  I  shall  pay  them 
a  more  particular  attention. 

Inflammation  takes  place  in  any  part  of  the 
body,  if  the  red  vessels  of  such  part  are  by  any  means 
deprived  of  a  portion  of  their  contractile  energy, 
and  their  powers  of  action  are  thereby  reduced 
below  the  similar  powers  of  the  system  generally. 
This  condition,  it  must  be  observed,  is  absolutely 
necessary  to  the  production  of  inflammation;  for 
if  all  the  vessels  in  the  body  were,  at  the  same 
time,  and  to  the  same  extent,  deprived  of  their 
contractile  energy,  though  much  atony  might  fol- 
low, inflammation  could  not;  for  the  quantity  of 
action  being  equal  throughout  the  whole,  the  dis- 
tribution of  the  blood  would  also  be  equal:  and 
inflammation  cannot  exist  in  all  the  vessels  of  the 
body  at  the  same  time,  for  the  quantity  of  blood 
is  insufficient  to  produce  the  necessary  distention. 


On  Inflammation.  17 

Inflammation  then  consists  in  a  loss  of  tone,  and 
consequent  weakened  action  of  the  vessels  diseased. 
Loss  of  tone  of  the  muscular  fibres  is  always  at- 
tended with  diminished  secretion  and  excretion, 
consequently  diminished  irritability  of  the  nervous 
fibres  with  diminished  sensibility;  therefore,  dimi- 
nished secretion,  excretion,  irritability,  and  sensibi- 
lity, are  the  consequences  of  inflammation  to  the 
part  diseased. 

Although  inflammation  is,  in  itself,  weakened 
action,  as  described  above,  it  is  a  direct  stimulant 
power  to  every  other  part  of  the  system.  Hence 
the  consequences  to  the  general  system  will  vary 
according  to  the  extent  of  the  disease  and  the  part 
affected.  When  inflammation  comes  on  in  the 
neighbourhood  of  many  nervous  fibres,  as  in  the 
vessels  of  the  skin,  cellular  membrane,  or  volun- 
tary muscles,  pain  will  attend  in  proportion  to  the 
tumefaction;  because  the  greater  the  tumefaction, 
the  greater  will  be  the  pressure;  consequently  the 
greater  the  stimulant  power  of  the  disease  on  the 
surrounding  parts.  The  pain,  in  this  instance,  is 
not  to  be  referred  to  the  nerves  immediately  in- 
volved in  the  disease;  for  these,  notwithstanding 
they  are  operated  upon  by  a  powerful  exciting  cause, 
have  their  sensibility  so  much  diminished,  in  consi- 
derable degrees  of  inflammation,  as  to  be  hardly 
excitable  ;  but  to  the  nerves  immediately  surround- 
ing the  diseased  part,  which  have  their  sensibility 
increased  in  consequence  of  such  stimulation.  In 
some  cases,  the  pain  is  removed  still  farther  from 

c 


18  On  Inflammation. 

the  seat  of  the  disease;  as  in  inflammation  of  the 
liver,  with  pain  in  the  shoulder,  or  in  the  blad- 
der, or  at  the  extremity  of  the  urethra.  The 
increased  heat,  which  often  attends  inflammations 
of  these  parts,  is  to  be  referred,  in  like  manner, 
to  the  pressed  upon  and  highly  excited  arteries, 
in  the  neighbourhood  of  the  disease.  And  that  the 
heat,  after  being  secreted  by  these  vessels,  should 
accumulate  on  the  diseased  part,  is  not  unaccount- 
able, seeing  the  secretion  of  the  perspirable  matter 
is  suspended,  or  very  much  diminished,  which  is 
known  in  ordinary  cases  to  carry  off  a  large  portion 
of  the  sensible  caloric.  If  parts,  with  few  nerves, 
as  the  liver,  lungs,  &c.  become  inflamed,  the  pain 
will  be  proportionably  small ;  if  without  nerves,  as 
the  pleura,  tendons,  &c.  pain  will  be  altogether 
absent.* 

Inflammations,  while  confined  to  a  point,  and 
not  very  painful,  by  their  gentle  stimulant  power 
often  invigorate  weak  constitutions:  hence  the 
good  effects  of  setons,  issues,  blisters,  &c.  but 
when  much  extended,  whether  very  painful  or  not, 
their  stimulant  power  becomes  so  much  increased 
as  to  excite  a  quantity  of  action  incompatible  with 
health,  and  one  therefore  which  cannot  be  conti- 
nued. A  very  great  quantity  of  action  seems  to 
be  incompatible  with  life  and  health;  for  this  rea- 
son, that  secretion  being  in  proportion  to  the  quan- 
tity of  action,  the  blood  becomes  rapidly  diminish- 

*  See  the  Experiments  of  Mr.  Monro. 


On  Inflammation,  19 

ed,  removing  thereby  not  only  an  exciting  cause  of 
vascular  action,  but  diminishing  the  secretion  of 
the  vital  principle;  which,  under  certain  circum- 
stances, becomes  both  the  remote  and  immediate 
causes. 

Every  organ  entering  into  the  composition  of 
animal  bodies,  must  be  considered  in  two  points 
of  view;  first,  as  performing  its  own  functions  as 
an  individual;  secondly,  from  its  connection  with, 
and  action  upon  the  other  parts,  as  a  stimulant 
power,  exciting  every  other  organ  to  increased 
action.  Some  organs,  therefore,  as  the  brain, 
stomach,  intestines,  and  lungs,  from  the  great 
quantity  of  action  which  they  perform  in  them- 
selves, and  excite  throughout  the  body,  have  been 
called  centres  of  association  to  the  motions  gene- 
rally. Now,  notwithstanding  inflammation  is  a 
stimulant  power,  and  as  such  generally  increases 
the  action  of  every  part  not  immediately  involved 
in  the  disease,  yet  being  in  itelf  diminished  action, 
if  it  affects  any  of  the  organs  above  named,  the 
quantity  of  action  of  the  whole  system  will  be 
thereby  diminished ;  for  the  body  sustains  a  greater 
loss  of  stimulant  power  from  any  one  of  its  capital 
organs  becoming  inflamed,  and  its  motions  thereby 
suspended,  than  it  gains  from  the  inflammation 
itself.  Hence  weak  pulse,  and  frequently  dimi- 
nished heat,  in  phrenitis  (if  such  disease  exists), 
gastritis,  enteritis,  and  some  cases  of  peripneumo- 
nia. 

In  setting  down  phrenitis,  or  inflammation  of  the 


20  On  Inflammation. 

brain,  as  a  disease  of  general  decreased  action,  I 
have  differed  materially  from  Cullen,  as  may  be 
seen  by  turning  to  his  history  of  that  disease.  But 
I  am  not  the  first  who  have  ventured  to  question 
the  existence  of  a  perfect  case  of  such  inflamma- 
tion, upon  the  ground  that  life  would  be  discon- 
tinued long  before  it  became  universal.  Some 
partial  cases  of  inflammation  of  the  brain  I  have 
seen  in  the  latter  stages  of  malignant  fevers;  but 
they  have  been  in  every  instance  marked  by  stupor 
and  loss  of  voluntary  motion.  I  have  also  seen 
some  cases  of  disease  where  the  brain  appeared  to 
be  highly  excited  from  inflammation  of  the  neigh- 
bouring parts.  These  cases  assumed  the  character 
of  Cullen's  phrenitis. 

From  not  discovering  or  attending  exactly  to 
the  seat  of  inflammation,  physicians  have  some- 
times been  led  into  other  errors  of  opinion,  of  the 
nature  of  the  above.  For  instance,  Dr.  Darwin 
asserts  that  the  liver  inflamed  performs  more  secre- 
tion than  in  health.  The  principle  I  have  laid  down 
will,  however,  explain  all  such  mistakes.  Physi- 
cians have  also  misled  themselves  and  others,  with 
respect  to  the  nature  of  inflammation,  by  gathering 
symptoms  for  it  from  parts  in  which  it  did  not 
exist.  For  instance,  John  Hunter  says,  "  The 
act  of  inflammation  would  appear  to  be  an  in- 
creased action  of  the  vessels.  Inflammation  in  a 
part  is  not  only  an  action  of  the  smaller  vessels  in 
the  part  itself,  but  in  the  larger  vessels  leading  to 
it.    This  is  proved  by  a  whitlow  taking  place  on 


On  Inflammation.  21 

the  end  of  a  finger ;  for  although  inflammation 
itself  shall  be  confined  to  the  end  of  a  finger,  and 
the  inflammatory  sensation  or  throbbing  be  situ- 
ated in  this  part,  yet  we  can  feel  by  our  hands, 
when  we  grasp  the  finger,  a  strong  pulsation  in 
the  two  arteries  leading  to  the  inflamed  part; 
while  no  such  pulsation  can  be  felt  in  the  other 
fingers."* 

But  Dr.  Hunter  might  have  observed,  that  while 
there  was  no  evidence  of  increased  action  in  the 
vessels  of  the  diseased  part,  these  arteries  of  which 
he  has  spoken  were  not  themselves  actually  diseased, 
but  in  the  neighbourhood  of  the  disease,  and  there- 
fore stimulated  by  it ;  and  that  the  increased  action 
of  highly  excited,  but  healthy  vessels,  could  not 
be  admitted  as  evidence  of  increased  action  of 
vessels  in  other  situations,  and  under  other  circum- 
stances: and  although  no  such  pulsation  existed  in 
the  arteries  of  the  other  fingers,  yet  the  action  of 
these,  as  well  as  of  every  other  artery  in  the  body, 
was  increased  in  proportion  to  the  violence  and 
extent  of,  and  the  distance  from  the  diseased  part. 

Inflammation  is  most  easily  excited  in  weak  and 
delicate  habits,  and  therefore  occurs  oftenest  in 
such ;  it  is  also  liable  to  accompany  other  diseases 
of  debility,  as  dropsy,  &c.  as  was  well  observed  by 
Dr.  RusH.f  Nor  need  those  who  know  that  in  all 
cases  of  debility  every  cause  of  inflammation  always 


*  See  Hunter  on  Inflammation 
f  See  Medical  Inquiries. 


22  On  Inflammation. 

exists,,  except  the  proximate,  be  alarmed  at  the  fre- 
quent occurrence  of  that  also.  Hence  the  opinion 
advanced  by  Dr.  Mease,  ought  not  to  startle  any- 
one, unless  correct  opinions  among  medical  gen- 
tlemen be  allowed  to  startle  on  account  of  their 
rarity.* 

It  will  be  observed,  that  I  have  often  used  the 
word  secretion,  in  the  course  of  this  dissertation ; 
and  have  endeavoured  to  show  that  it  was  dimi- 
nished in  inflammation,  as  well  as  in  every  state  of 
vascular  debility;  it  therefore  becomes  proper  to  ex- 
plain what  I  mean  by  that  term.  Secretion  may  be 
denned  an  action  of  the  vessels,  whereby  the  blood 
is  decompounded,  and  new  compounds  formed,  for 
the  peculiar  and  healthful  purposes  of  the  animal. 
I  am  aware,  that  if  any  fluid  secreted  in  health 
should  be  found  to  correspond  exactly  in  all  its  pro- 
perties to  some  portion  of  the  blood,  it  would 
form  an  objection  to  this  definition;  but  until  such 
fluid  be  pointed  out,  I  must  continue  to  believe  it 
accurate. 

If,  however,  a  great  degree  of  relaxation  at  the 
extremities  of  the  vessels  should  suffer  some  parts 
of  the  blood,  from  their  greater  tenuity,  to  run  off 
unchanged,  this  could  not  be  termed  secretion, 
with  any  more  propriety  than  we  should  call  ordi- 
nary haemorrhage  by  that  appellation.  Therefore, 
those  discharges  which  often  obtain  from  inflamed 
surfaces,  as  well  as  those  which  are  made  beneath 

*  See  Med.  Rep.  vol.  i.  p.  149. 


On  lnfiammation.  23 

the  skin,  into  the  cellular  membrane,  &c.  in  cases  of 
extreme  debility,  as  the  vibices  of  malignant  fevers, 
and  the  blisterings  frequently  preceding  gangrene, 
are  not  to  be  termed  secretions,  as  they  are  not  the 
result  of  vascular  action,  but  suffered  to  take  place 
merely  through  debility ;  and  the  different  dis- 
charges in  these  cases  mark  the  degree  of  debility 
very  exactly.  Thus,  where  the  serum  only,  which 
is  the  finest  portion  of  the  blood,  is  discharged, 
the  most  moderate  degree  of  inflammation  exists, 
and  one  which  may  continue  a  long  time  under  the 
same  appearances ;  as  in  fistulous  ulcers,  gonorrhoea, 
&c. 

If,  however,  the  degree  of  inflammation  is  by  any 
means  a  little  increased,  a  second  portion  of  the 
blood  will  also  be  poured  out  with  the  serum,  and 
the  condition  of  the  part  thereby  materially  chang- 
ed; manifesting  all  the  phenomena  of  adhesive  in- 
flammations, as  in  the  healing  of  wounds,  ulcers, 
&c.  for  this  second  portion,  or  the  coagulating 
lymph,  is  the  fluid  of  which  the  animal  solids  are 
formed,  and  to  which,  whether  in  the  vessels  or 
not,  life  is  pre-eminently  attached.  If  the  degree 
of  inflammation  is  carried  still  higher,  a  state  of 
debility  is  induced  incompatible  with  the  life  of  the 
vessels;  therefore  spreading  of  the  ulcers,  or  morti- 
fication of  the  part,  must  follow. 


{     24     ) 


CAUSES  OF  INFLAMMATION. 

A  quantity  of  action  so  great  as  to  expend  the 
vital  principle  faster  than  it  can  be  supplied,  is 
the  most  frequent  remote  cause  of  inflammation. 
Those  stimulant  powers  which  excite  this  great 
quantity  of  action,  are  the  pre-remote  causes.  The 
subduction  of  the  stimulant  powers,  as  in  the  ex- 
posure of  a  part  to  cold,  and  the  consequent  loss  of 
action,  are  frequently,  too,  the  remote  causes  of  this 
disease.  In  short,  whatever  induces  debility  imme- 
diately, may  cause  inflammation  remotely. 

Debility,  then,  by  whatever  means  induced,  stands 
next  in  order  to  be  considered  as  a  cause  of  inflam- 
mation: it,  however,  from  its  apparently  passive  na- 
ture, cannot  be  well  called  exciting  or  disposing, 
and  having  no  other  appellation  at  hand,  I  shall 
leave  it  to  the  reader  to  name. 

The  proximate  cause  of  inflammation  is  pointed 
out  by  the  condition  laid  down  above;  which  was, 
that  the  vessels  of  the  general  system  should  pos- 
sess sufficient  power  to  push  on  their  contents,  and 
distend  such  vessels  as  were  unable,  through  de- 
bility, to  rid  themselves  of  such  contents  after  re- 
ceiving them.  For  it  will  be  easily  seen,  and 
may  be  seen  every  day,  that  the  remote  cause  of 
inflammation  has  acted,  and  ended  in  debility;  yet 
the  disease  does  not  appear,  unless  the  debilitated 
vessels  become  over-distended  with  red  blood:  the 


On  Inflammation.  25 

power,  therefore,  which  distends  these  vessels  is 
the  proximate  cause,  and  this  power  is  the  activity 
of  the  other  parts  of  the  system.  But  in  order  to 
the  distention  taking  place,  it  is  not  necessary  that 
the  healthy  parts  should  act  with  unusual  energy, 
or  that  blood  be  derived  to  the  weakened  part  in 
greater  quantity  than  usual ;  for  if  it  is  derived  at 
all,  and  retained  in  greater  proportion,  the  disease 
must  necessarily  take  place. 

By  way  of  illustration  to  my  general  doctrine,  I 
shall  set  down  the  causes  of  inflammation  m  the 
order  of  their  occurrence,  and  the  production  of 
the  disease  in  question. 

These  I  expect  to  find  happily  arranged  to  my 
purpose,  in  the  case  of  inflammation  spreading  from 
a  point  to  the  surrounding  parts.   Nor  can  the  tak- 
ing of  a  case  of  inflammation,  which  is  to  be  con- 
sidered as  having  existed  for  some  time,  form  any 
objection  to  the  statement,  because,  while  the  dis- 
ease continues  to  spread,  all  the  causes  are  pre- 
sumed to  be  in  full  operation.     Now,  the  inflamed 
point  which  stimulates  the  surrounding  parts  is  the 
pre-remote  cause;  the  quantity  of  action  which  is 
excited  by  the  pre-remote,  and  ends  in  indirect  de- 
bility, is  the  remote  cause:  in  consequence  of  this 
debility,  thus  induced,  the  vessels  suffer  themselves 
to  be  over-distended  by  the  proximate  cause,  and 
the  disease  appears.    That  redness  and  tumefaction 
which  often  attend  the  exposure  of  a  part  to  cold, 
appear  to  be  a  perfect  case  of  inflammation,  and 
throw  much  light  on  the  nature  and  production  of 
that  disease. 


(     26     ) 


CURE. 

The  cure  of  inflammation  may  be  attempted 
on  several  grounds:  first,  by  the  removal  of  the 
proximate  cause,  as  in  bleeding,  purging,  &c. 
secondly,  by  diminishing  the  power  of  the  remote 
cause,  as  in  the  application  of  cold  and  other  se- 
datives to  the  part  affected:  thirdly,  by  removing 
the  debility  of  the  diseased  vessels,  by  the  applica- 
tion of  astringents  and  stimulants  to  them. 


THE  END. 


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